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OTIPM: A model for implementing top-down,
client-centered, and occupation-based
assessment, intervention, and documentation
Developed by Professor Anne G. Fisher, ScD, OT, FAOTA
The OTIPM rescued me from an “OT-depression”! Half of my clients
did not need OT, they needed
physiotherapy. After I learned the OTIPM, I made sure the OT
referrals were appropriate and took
more time for the “interviewing–observing–goal-setting–process,”
and I focused more on education
and compensation. Nothing totally new, but still it changed
something. I gained more OT self-esteem
and joy in my work.
We changed our documentation system. And we “threw out” the old
tests, and now we focus on
“performance of prioritized activities.” Even one of the most
“body-function-working OT colleagues”
are enthusiastically reporting that they are reaching goals more
easily and faster!
Katharina, 2015
Overview
This 3-day course is ideal for occupational therapy
practitioners, educators, and researchers who want
to implement best possible occupation-based and
occupation-focused services. The course content
progresses step-by-step through the phases of the occupational
therapy process. Lectures, video case
examples, and extensive opportunities to practice enable the
course participants to reflect on and learn
strategies they can apply to improve their practice, educational
activities, and research.
While this course is based on the Occupational Therapy
Intervention Process Model (OTIPM, Fisher,
2009; Fisher & Jones, in press). the emphasis is on the
practical application of the OTIPM as a
professional reasoning model that helps the occupational
therapist practice in a more client-centered,
top-down, occupation-based, and occupation-focused manner. The
occupational therapists who take
this course find that they leave inspired to make their practice
more centered on occupation.
A major premise of the OTIPM is that focusing our evaluations on
the client’s quality of occupational
performance, focusing our interventions directly on enhancing or
maintaining occupational performance,
and using occupation as a primary method for both evaluation and
intervention all depend on a
concurrent commitment to true top–down and client-centered
practice. When we embrace these
fundamental principles of occupation-based and
occupation-focused services, occupational therapists
will:
• Document measureable and occupation-focused baselines, goals,
and outcomes
• Use occupation-based and occupation-focused evaluation and
intervention methods to enhance the
quality and effectiveness of the services they provide
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• Advocate for and promote the distinct value of occupational
therapy to consumers, third-party
payers, and other professionals
• Value the contributions of occupational therapy to health care
and health promotion
Background
Based on her 1998 Eleanor Clarke Slagle Lectureship, Professor
Fisher brings together 50 years of
experience to present a model for professional reasoning. The
OTIPM is a professional reasoning model
that occupational therapists can use to ensure that they adopt
an occupation-centered (OC) perspective
to guide their reasoning as they plan and implement
occupation-based (OB) and occupation-focused (OF)
services (Fisher, 2013).
In the OTIPM, the occupational therapy process is depicted as
occurring over three global phases,
evaluation and goal-setting, intervention, and reevaluation, and
each step in the process may be OB, OF,
or both (Fisher, 2013). The steps of the occupational therapy
process defined in the OTIPM are
represented schematically below (see Figure 1).
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Who Should Attend?
• Occupational therapists who want to change their practice and
implement services that are
occupation-based and occupation-focused.
• Occupational therapists who already practice in a manner with
which they are satisfied—attending
this course will enable them to reflect on and evaluate their
current practice and identify components
that they can further improve so as to become even more
occupation-centered.
• Occupational therapist who want to change practice and are
struggling with where to start in order
to overcome the many obstacles that limit what they can do.
Course Description
While the OTIPM is a professional reasoning model, the emphasis
of this course is on the practical
application of the OTIPM in practice. A variety of individual
and group activities provide the course
participants with opportunities to implement (a) nonstandardized
occupation-focused and occupation-
based evaluations of quality of a person’s occupational
performance, including the performance of daily
life tasks that involve social interaction, and (b)
occupation-focused documentation. Video case examples
are used to reinforce learning.
Course Objectives
At the conclusion of a 3-day OTIPM workshop, the participants
will understand:
• The occupation-centered professional reasoning process defined
in the OTIPM
• Distinctions between occupation-centered reasoning and
occupation-based and occupation-focused
practice
• The various types of evaluations and interventions
occupational therapists commonly use and which
ones are occupation-based or occupation-focused
• How to apply true top–down and occupation-centered reasoning
in the context of implementing
occupation-based and occupation-focused services
• How to implement nonstandardized observation-based performance
analyses of a person’s quality of
occupational performance
• How to write occupation-focused documentation, including
observable and measureable client-
centered goals
• When and how to link other occupational therapy models of
practice and evaluation methods into
the occupational therapy intervention process
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Course Schedule
Day 1 — 8:30 to 10:00 Introduction to the course Developing a
common language 10:00 to 10:30 Break 10:30 to 12:00 Developing a
common language (continued) Introduction to the OTIPM 12:00 to 1:15
Lunch 1:15 to 3:00 Case application — Client-centered performance
context 3:00 to 3:30 Break 3:30 to 4:30 Document background
information, reason for referral, and self-reported level
of occupational performance Day 2 — 8:30 to 10:00 Case
application — Implement performance analysis (motor and process
skills) 10:00 to 10:30 Break 10:30 to 12:00 Case application —
Document baseline level of performance and client-
centered goals 12:00 to 1:15 Lunch 1:15 to 3:00 Case application
— Document client-centered goals (continued) 3:00 to 3:30 Break
3:30 to 4:30 Case application — Plan intervention Document
intervention plan Reevaluate and document result Day 3 — 8:30 to
9:15 Introduction to a general OT program based on OTIPM 9:15 to
10:00 Case application — Implement performance analysis (social
interaction skills) 10:00 to 10:30 Break 10:30 to 12:00 Case
application — Document baseline level of performance and
client-
centered, occupation-focused goals 12:00 to 1:15 Lunch 1:15 to
1:45 Case application — Plan intervention and evaluate results 1:45
to 3:00 Framing function from an unique occupational therapy
perspective Some final thoughts Implementing changes in practice —
Overcoming obstacles 3:00 to 3:30 Break 3:30 to 4:30 Implementing
changes in practice — Overcoming obstacles (continued) Final
reflections
Note. The schedule presented here may vary, depending on group
interest and needs. Exact times for
breaks and lunch also may vary slightly, depending on the
schedule of the course setting.
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Selected References
Fisher, A. G. (2013). Occupation-centred, occupation-based,
occupation-focused: Same, same or
different? Scandinavian Journal of Occupational Therapy, 20,
162–173. DOI: 10.3109/11038128.2012.
754492
Fisher, A. G. (2009). Occupational Therapy Intervention Process
Model: A model for planning and
implementing top–down, client-centered, and occupation-based
interventions. Ft. Collins, CO: Three Star
Press.
Fisher, A. G., & Griswold, L. A. (2013). Performance skills:
Implementing performance analyses to
evaluate quality of occupational performance. In B. B. Schell,
G. Gillen, M. Scaffa , & E. Cohn (Eds.), Willard
& Spackman’s occupational therapy (12th ed., pp. 249–264).
Philadelphia: Lippincott Williams & Wilkins.
Fisher, A. G. & Jones, K. B. (2017). Occupational Therapy
Intervention Process Model. In J. Hinojosa,
P. Kramer, & C. B. Royeen. Perspectives on human occupation:
Theories underlying practice (2nd ed., pp.
237–286). Philadelphia: Wolters Kluwer|Lippincott Williams &
Wilkins.
(Note. For additional references, go to
http://www.innovativeotsolutions.com/content/otipm/references/)
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Develop therapeutic rapport and work
collaboratively with client
Define and describe task actions the client
does and does not perform effectively
Select a model for education and
teaching
Reevaluate for enhanced and satisfying
occupationalperformance
Identify client’s reported and prioritized strengths
and problems of occupational performance
Observe client’s performance of prioritized
tasks and implement performance analyses
Select the compensatory
model
Plan and implement adaptive occupation to
compensate for decreased occupational skill
Select a model for enhancement of person
factors and body functions (restorative model)
Select a model for occupational skills
training(acquisitional model)
Plan and implement restorative occupation to restore or develop
person factors and body functions
Clarify or interpret the reason(s) for client’s
problems of occupational performance
Identify resources and limitations within
client-centered performance context
Establish, finalize, or redefine client-centered and
occupation-focused
goals
Evaluation and goal-setting phase Intervention phase
Reevaluation phase
Establishclient-centered
performance context
Plan and implement educational programs
for groups focusedon performance of
daily life tasks
Plan and implement acquisitional occupation to reacquire or
develop
occupational skill
Adapted from: Fisher, A. G. (2009). Occupational Therapy
Intervention Process Model: A model for planning and implementing
top-down, client-centered, and occupation-based interventions. Fort
Collins CO: Three Star Press. (Revised June 2013)
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Occupational Therapy Intervention Process Model
(OTIPM) — Note Taking Worksheet
Client-centered Performance Context: Resources and
Limitations
Consider past, present, and future or each dimension
Environmental
dimension
Role
dimension
Motivational
dimension
Task
dimension
Cultural
dimension
Social
dimension
Societal
dimension
Body function
dimension
Temporal
dimension
Adaptation
dimension
Reason for
referral
Strengths and Problems of Reported Occupational Performance
Tasks performed well and/or
with satisfaction
Task performed with problems
and/or with dissatisfaction
Tasks potentially problematic
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Occupational Therapy Intervention Process Model
(OTIPM) — Note Taking Worksheet
Actions (Performance Skills) Performed Effectively or
Ineffectively
Motor skill Behavior (action) observed Judgment
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Updated 29 April 2016
Occupational Therapy Intervention Process Model
(OTIPM) — Note Taking Worksheet
Actions (Performance Skills) Performed Effectively or
Ineffectively
Process skill Behavior (action) observed Judgment
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Occupational Therapy Intervention Process Model
(OTIPM) — Note Taking Worksheet
ADL Motor and ADL Process Skill Specific Baseline Statements
Skills included in the cluster Specific baseline statement
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Updated 29 April 2016
Occupational Therapy Intervention Process Model
(OTIPM) — Note Taking Worksheet
Actions (Performance Skills) Performed Effectively or
Ineffectively
Social interaction skill Behavior (action) observed Judgment
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Updated 29 April 2016
Occupational Therapy Intervention Process Model
(OTIPM) — Note Taking Worksheet
Social Interaction Skill Specific Baseline Statements
Skills included in the cluster Specific baseline statement
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Updated 29 April 2016
Occupational Therapy Intervention Process Model
(OTIPM) — Documentation Worksheet
Background information
Reason for referral
Reported current level of performance
Priorities
Observed current status (global baseline)
Actions of performance (performance skills) of most concern
(specific baseline)
Goals
Interpretation
Intervention plan
Potential to benefit from intervention
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Dancza, K., Copley, J., Rodger, S., & Moran, M. (2016). The
development of a theory-
informed workbook as an additional support for students on
role-emerging placements.
British Journal of Occupational Therapy, 79, 235–243.
https://doi.org/10.1177/
0308022615612806
Ericksen, J. B. (2009). Critical reflections on school-based
occupational therapy.
Scandinavian Journal of Occupational Therapy, 17, 64–69.
https://doi.org/10.3109/
11038120903160736
Fisher, A. G. (2013). Occupation-centred, occupation-based,
occupation-focused: Same,
same or different? Scandinavian Journal of Occupational Therapy,
20, 162‒173.
https://doi.org/10.3109/11038128.2012.754492
Fisher, A. G. (2009). Occupational Therapy Intervention Process
Model: A model for
planning and implementing top-down, client-centered, and
occupation-based interventions.
Ft. Collins, CO: Three Star Press.
Fisher, A. G. (2006). Overview of performance skills and client
factors. In H. M.
Pendleton, & W. Schultz-Krohn (Eds.), Pedretti’s
occupational therapy: Practice skills for
physical dysfunction (6th ed., pp. 372–402). St. Louis MO: Mosby
Elsevier.
Fisher, A. G. (1998). Uniting practice and theory in an
occupational framework: 1998
Eleanor Clarke Slagle Lecture. American Journal of Occupational
Therapy, 52, 509–521.
https://doi.org/10.5014/ajot.52.7.509
Fisher, A. G., Atler, K., & Potts, A. (2007). Effectiveness
of occupational therapy with
frail community living older adults. Scandinavian Journal of
Occupational Therapy, 14, 240–
249. https://doi.org/10.1080/11038120601182958
Fisher, A. G., Bryze, K., Hume, V, & Griswold, L. A. (2007).
School AMPS: School
Version of the Assessment of Motor and Process Skills (2nd ed.).
Ft. Collins, CO: Three Star
Press.
Fisher, A. G., & Griswold, L. A. (2014). Performance skills:
Implementing performance
analyses to evaluate quality of occupational performance. In B.
A. B. Schell, G. Gillen, & M.
E. Scaffa (eds.), Willard & Spackman’s occupational therapy
(12th ed., pp. 249–264).
Philadelphia: Lippincott Williams & Wilkins.
Fisher, A. G., & Griswold, L. A. (2018). Evaluation of
Social Interaction (4th ed.). Fort
Collins, CO: Three Star Press.
Fisher, A. G., & Jones, K. B. (2012). Assessment of Motor
and Process Skills. Vol. 1:
Development, standardization, and administration manual (7th
Rev. ed.). Fort Collins, CO:
Three Star Press.
References: Occupational Therapy
Intervention Process Model (OTIPM)
https://doi.org/10.1177/0308022615612806https://doi.org/10.1177/0308022615612806https://doi.org/10.3109/11038120903160736https://doi.org/10.3109/11038120903160736https://doi.org/10.3109/11038128.2012.754492https://doi.org/10.5014/ajot.52.7.509https://doi.org/10.1080/11038120601182958
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Updated 5 March 2018
Fisher, A. G. & Jones, K. B. (2017). Occupational Therapy
Intervention Process Model.
In J. Hinojosa, P. Kramer, & C. B. Royeen. Perspectives on
human occupation: Theories
underlying practice (2nd ed., pp. 237–286). Philadelphia:
Wolters Kluwer|Lippincott
Williams & Wilkins.
Fisher, A. G., & Nyman, A. (2011). OTIPM: En model för ett
professionellt resonemang
som främjar bästa praxis i arbetsterapi (FOU-rapport 2007)
[OTIPM: A model for
professional reasoning that promotes best practice in
occupational therapy] (revised ed.).
Nacka, Sweden: Förbundet Sveriges Arbetsterapeuter.
Hällgren, M., & Kottorp, A. (2005). Effects of occupational
therapy program in activities
of daily living and awareness of disability in persons with
intellectual disabilities. Australian
Occupational Therapy Journal, 52, 350–359.
https://doi.org/10.1111/j.1440-1630.2005.
00523.x
Kottorp, A., Hällgren, M., Bernspång, B., & Fisher, A. G.
(2003). Client-centred
occupational therapy for persons with mental retardation:
Implementation of an intervention
programme in activities of daily living tasks. Scandinavian
Journal of Occupational Therapy,
10, 51–60. https://doi.org/10.1080/11038120310009416
Larsson-Lund, M., & Nyman, A. (2017). Participation and
occupation in occupational
therapy models of practice: A discussion of possibilities and
challenges. Scandinavian
Journal of Occupational Therapy, 24, 393–397.
https://doi.org/10.1080/11038128.2016.
1267257
Lindström, M., Hariz, G. M., & Bernspång, B. (2012). Dealing
with real-life challenges:
Outcome of a home-based occupational therapy intervention for
people with severe
psychiatric disability. Occupational Therapy Journal of
Research, 32, 5–13.
https://dx.doi.org/10.3928/15394492-20110819-01
Simmons, D. C., & Griswold, L. A. (2010). Using the
Evaluation of Social Interaction in
a community-based program for persons with traumatic brain
injury. Scandinavian Journal of
Occupational Therapy, 17, 49–56.
https://doi.org/10.3109/11038120903350303
Sirkka, M., Larsson-Lund, M., & Zingmark, K. (2014).
Occupational therapists'
experiences of improvement work: A journey towards sustainable
evidence-based practice.
Scandinavian Journal of Occupational Therapy, 21, 90–97.
https://doi.org/10.3109/
11038128.2013.872183
Zingmark, M., Fisher, A. G., Rocklöv, J., & Nilsson, I.
(2014). Occupation-focused
interventions for well older people: An exploratory randomized
controlled trial. Scandinavian
Journal of Occupational Therapy, 21, 447–457.
https://doi.org/10.3109/11038128.2014.
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https://doi.org/10.1111/j.1440-1630.2005.00523.xhttps://doi.org/10.1111/j.1440-1630.2005.00523.xhttps://doi.org/10.1080/11038120310009416https://doi.org/10.1080/11038128.2016.1267257https://doi.org/10.1080/11038128.2016.1267257https://dx.doi.org/10.3928/15394492-20110819-01https://dx.doi.org/10.3928/15394492-20110819-01https://doi.org/10.3109/11038120903350303https://doi.org/10.3109/11038128.2013.872183https://doi.org/10.3109/11038128.2013.872183https://doi.org/10.3109/11038128.2014.927919https://doi.org/10.3109/11038128.2014.927919
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